Organization
KT PLAZA PHARMACY, INC.
Active
Other names
KT plaza pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
JAMIE PARK (PHARAMCIST/PIC)
(213) 382-0212
Entity
Organization
Contact information
Practice address
928 S WESTERN AVE, STE 110, LOS ANGELES, CA 90006-1000
(213) 382-0212
(213) 382-0812
Mailing address
928 S WESTERN AVE, STE 110, LOS ANGELES, CA 90006-1000
(213) 382-0212
(213) 382-0812
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
54469
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1811035801
—
CA
01
—
2162516
PK
—
Enumeration date
02/02/2007
Last updated
04/17/2017
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